Inslee puts pause on termination of health departments, calling politics in public health ‘reckless and dangerous’

Gov. Jay Inslee issued a proclamation Monday halting the termination of a city-county health department or the withdrawal from a health district until the COVID-19 state of emergency is over, as local public health districts face continued politicization.

The proclamation was announced just one day before a vote in the Pierce County Council to break its county-city health department agreement. The Tacoma-Pierce County Health Department has received attention in the past few weeks after members of the county council proposed breaking a decades-long agreement between Tacoma and Pierce County to share a health department.

“The pause is necessary to ensure that we have a continuity and a stability of our public health efforts,” Inslee said in a Monday news conference.

The proclamation pauses any attempt to withdraw membership from a health district or to terminate an agreement that establishes a city-county health department.

The exceptions to the proclamation are when both parties of the city-county department or all members of the health district agree to the termination or withdrawal, or when the party seeking to terminate the agreement or withdraw receives approval from the Washington secretary of health. The secretary of health must determine the decision would not adversely affect the COVID-19 pandemic response.

Similar to the firing of former Spokane Regional Health District health officer Dr. Bob Lutz, the debate in Tacoma is just one example of the continued polarization of public health during the pandemic.

According to a poll from the Associated Press released Tuesday, at least 181 state and local public health department leaders have resigned, retired or been fired during the pandemic. One in eight Americans lives in a community that has lost its local public health department leader during the pandemic, and top health officials in 20 states have left state-level departments.

In Washington, Secretary of Health John Wiesman and State Health Officer Dr. Kathy Lofy announced their resignation this year.

The proclamation praises local health jurisdictions for their role in the pandemic response, as it is “never more important than during a deadly public health crisis and pandemic.” It also called the public discourse around restructuring of a health department “demoralizing and distracting to the critical essential staff of the department or district at a time when staff are already overwhelmed.”

Inslee called politics in public health “reckless and dangerous” at this moment, adding that this pause will help eliminate that.

Washington’s public health system is decentralized, meaning the power is in local jurisdictions to make laws for their community. The state has a few types of public health departments:

• A city-county health department, like Tacoma-Pierce and Seattle-King;
• A countywide health district, such as the Spokane Regional Health District;
• A multicounty health district, such as the Northeast Tri-Counties Health District;
• A district in a county without a home-rule charter where the board of health is made up of the county commissioners.

Public health officials have been struggling for years with a lack of resources and funding, said Jeff Ketchel, executive director at the Washington State Public Health Association. As the population and the complexities of public health have increased, staffing and funding have decreased.

“It makes things more challenging to implement or respond to when you don’t have the infrastructure to begin with,” Ketchel told The Spokesman-Review on Tuesday.

Other health districts have dissolved in the past, and counties have decided to discontinue their relationship with the health district, Ketchel said. Before that can be done, the county should determine its other options for delivering public health services.

Because counties have the ultimate authority to determine what their public health district might look like, the ability to dissolve or restructure districts could happen anywhere in the state, he said.

“Change isn’t always bad,” Ketchel said, “but change of this magnitude should be gone into very thoughtfully.”

Since the firing of Lutz, groups in Spokane have been looking for ways to change the system by making it less political and more focused on health. The Public Health Action Coalition Team of Spokane formed after Lutz’s firing with a goal of holding the health board accountable, member Jerrie Allard said.

State Rep. Marcus Riccelli also plans to draft legislation next session that would require local public health boards to be made up of half elected officials and half those with a public health or medical backgrounds.

Current Washington law requires local public health boards to be made up by a majority of elected officials.

Riccelli said his proposal would help eliminate some of the politicization seen in public health.

“We’re in the midst of a pandemic, and we need leadership,” Riccelli told The Spokesman-Review in November. “We need health care professionals to be weighing in.”

Local public health districts are now tasked with administering the COVID-19 vaccine, what Ketchel called “the largest public health action in the history of our country.” Local districts will be the ones distributing the vaccines in Washington, at least initially to hospitals and long-term care facilities.

It’s another reason why Inslee decided to issue the proclamation.

The pause will allow public health districts to focus their effort on the vaccine, which he called “the most challenging chapter yet of our pandemic response.”